An American Doctor In China: What's Different?

People often ask me, “is your medical practice different in China compared to the U.S.?” Finally, after working in China for three years, I can now answer you with a definitive yes — and no. And sometimes Y…

OK, What’s Different?

#1 Difference: Chinese patient expectations - Last week I had another of many similar encounters: a young Chinese woman came in with typical common cold symptoms of runny nose and cough, and otherwise was fine. She made it very clear, very quickly, that she expected me to give her not just antibiotics, but IV antibiotics. Even after I explained to her that she only had a virus, she was quite flustered and still asked for the IV, telling me “you are very different than a local hospital”. Ahhhhh, yes indeed…

It is indeed true that we expat clinics are different than local hospitals. It’s common knowledge that Chinese hospitals have a startlingly high rate of antibiotic use, especially IV therapies, for viral illnesses that do not need antibiotics — like the common cold. It’s called “perverse incentives”: since deregulation in the 1980′s most Chinese hospitals rely on the revenue from prescriptions and procedures to pay their bills. So, Chinese patients are used to IV antibiotics for their colds; now, many newly-wealthy Chinese walk into a super-expensive expat clinic — and they only get over-the-counter meds and not even prescription antibiotics? You see the dilemma here.

Fortunately, with a lot of explanation and education — which they usually do not get from their 3-minute interaction with their local doctor — most patients will understand. And many also realize that their luxurious 15-20 minutes with the expat doctor, plus the organized appointment times and mellow waiting rooms, often make the extra expense worth it.

#2 Difference: Everyone’s super-healthy — or falling apart. In general, most Beijing expats are really healthy. They’re trim, they dress well, they’re at the gym 3 times a week, they eat organics off the farm — and they love it here. But there’s that other side of the expat world, the darker side that also loves it here but for less healthy reasons. That’s the type that smokes and drinks and sleeps around far more than they would ever consider doing back at home. I’m mostly concerned about the businessman mentality here, where it’s culturally accepted, if not indirectly coerced, to binge drink and smoke at business dinners — not to mention the implication that success allows you to have mistresses. I see a lot of broken marriages as well as alcoholism and chronic bronchitis in these types of expats, and I wonder if their often phenomenal business success was worth the trade-off in their physical and family health.

I feel that this is a major expat issue that I’ve been trying to address in my clinic and here on this website, and I hope to continue to show people a healthier lifestyle alternative — that you don’t have to sacrifice your family and your health to be successful in China. After all, when we are all old and at death’s door, will we be looking back upon our lives and thinking about our economic success, or fame, or business partners? Of course not; we’ll be thinking about our legacies of family and children and loved ones.

#3 Difference: Weird Diseases. As a family doctor, I see the full spectrum of diseases running through my community. I quickly noticed after coming to China (from a Sonoma county rural clinic) that the frequency and severity of chronic diseases was much lighter here. That’s for a good reason; few people with a major chronic disease would be physically qualified, much less interested, to work halfway around the world in the demanding, fast-paced business world of China.

So, my Beijing clinic days are filled less with out of control diabetics and alcoholic hepatitis patients, and more with acute stomach flu and the various respiratory Beijingitis syndromes. But I also get to see some unusual, more tropical-style diseases, as well as ones that are mostly wiped out in the West. For example, rabies (unfortunately) is a real issue here, while back in the States we’d never be running to the doctor every time a neighbor’s hamster bit your finger. And with all the travelling that expats do, I deal a lot more with tropical diseases with cool names like scombroid, schistosomiasis and ciguatera.

#4 Difference: Expats Are Cool. One definite perk is simply talking to my patients and listening to their stories as to why they are here and what adventures they are having. The range of countries and interests is fascinatingly broad, and my inner world is far wider just from living in Beijing and meeting such a diverse group.

OK, What’s The Same About Working Here vs America?

Well, that’s just not as interesting as the differences, is it? Perhaps for a later piece…

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